Millard-Gubler Syndrome

Excerpt

Millard-Gubler syndrome (MGS), also known as facial abducens hemiplegia syndrome or the ventral pontine syndrome, is an eponym after two French physicians, Auguste Louis Jules Millard and Adolphe-Marie Gubler who first described the features of this syndrome in 1858. MGS is one of the classical crossed brainstem syndromes, characterized by a unilateral lesion of the basal portion of the caudal pons involving fascicles of the facial (VII) cranial nerve and corticospinal tract fibers.

MGS is caused by a lesion in the ventral part of the pons (basis pontis) involving the infranuclear fascicular fibers of cranial nerve VII ipsilaterally and the corticospinal tract contralaterally. The result is ipsilateral peripheral facial paralysis and contralateral hemiplegia. CNVI is sometimes involved; however, as a medial structure, CNVI involvement was not described in the original case series of the eponymous syndrome reported by Millard and Gubler.

The lesion in MGS lies above the level of the decussation of the pyramidal and spinothalamic tracts. As a result, the cranial nerve signs are ipsilateral, whereas the limb symptoms are contralateral, resulting in the classical crossed brain stem syndrome.[3]

MGS often presents with other neurological deficits, such as contralateral hemiparesthesia and contralateral cerebellar ataxia, as many other tracts exist near the facial nerve nucleus. Ventral pontine syndromes may also arise secondary to demyelinating lesions, tumors, trauma, or infectious causes.